New Client Registration Form


Thank you for your interest in Body Mind Fitness!

This form is an opportunity for me to get to know you before we begin Personal Training, Private Yoga or Personalized Small Group Classes. I want to make sure that you're getting the most out of your time, so the more I know, the quicker we can get to what you need.

All of your responses will be kept strictly confidential.

I am looking forward to working with you towards your goals.

In gratitude,

Dominique
  • SECTION I: PERSONAL INFORMATION
    • First Name
      Last Name
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    • First Name
      Last Name
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    • Check all that apply.
  • SECTION II: HEALTH ASSESSMENT
    The following information will be used to help tailor your sessions to your physical needs.
    • Please check all that apply.
    • examples: incontinence (leaking urine or feces), pressure or pain "down there", pelvic organ prolapse (POP), uncomfortable or painful sex, lower back and/or pelvic pain, Diastasis Recti, constipation, urinary frequency or urgency, intersistial cystitis (painful bladder syndrome, chronic prostitise, endometriosis, IBS, issues with pregnancy or postpartum recovery, scar tissue, infertility or other.
    • Please describe level of activity (times per week, minutes per session)
    • Describe your meals and snacks.
    • Please be as specific as possible.
      Thank you :)
  • SECTION III: AGREEMENTS
    • 1. In consideration of participating in the "Activity", I agree and acknowledge that I am fully aware that participation in the Activity involves risks and I accept all the risks of participating, even if the risks are created by the carelessness, negligence or gross negligence of a Released Party (as defined below) or anyone else.

      2. "Claims" includes but is not limited to any and all liabilities, claims, demands, legal actions, rights of actions for damages, personal injury or death in connection with participation in the Activity. "Released Party" means Dominique Gauthier, Body Mind Fitness, or any of its affiliates, franchisees and their respective representatives, directors, officers, agents, employees or volunteer staff.
      2.1 Body Mind Fitness is a sole proprietorship based in the province of Ontario and may be referred as "us", "we", or "our". We will refer to you, the undersigned (electronically or by hand) or person who has clicked "I Agree" to this Waiver, as "I", "you" or "your").

      3. The Activities. You may participate in person or online; in yoga, strength and movement classes; personal training, private yoga sessions, teacher trainings, workshops and more with Dominique Gauthier, Body Mind Fitness, or any of its affiliates, franchisees and their respective representatives, directors, officers, agents, employees or volunteer staff. We offer levels of strengthening and accessible yoga, pilates classes, customized classes and programs, specialized training for the core and pelvic floor, and nutrition and dietary or meal planning suggestions all of which may involve but are not limited to the following ("Activities"):
      3.1 Stretching and flexibility training in the form of yoga, pilates poses, body weight and strength exercises, use of Equipment (as defined below), breath work, meditation and relaxation.
      3.2 Mobility training in the form of pilates positions, body weight exercises, use of Pilates equipment for stretching and resistance exercises, strength exercises, use of Equipment (as defined below), mobility, range of motion exercises, breathing exercises, and relaxation exercises.
      3.3 participation of in person and/or online personal training plan offered by the Trainer, which may include, but is not limited to a detailed and customized workout program, which may include but is not limited to: blocks, bolsters, straps, mats, resistance bands, pillows, dumbbells, barbells, TRX Suspension Trainer, foam rollers, massage balls, straps, mats, reformer, chair, tower, rings, resistance bands, cadillac, barrels, Gyrotonic pulley towers, Gyrotonic ladder, magic circle, spinal corrector, stability and rotational discs, balance pods, BOSU ball, stability ball, pilates ball (the "Equipment"). Please do not use any equipment not instructed by Dominique Gauthier, Body Mind Fitness, or any of its affiliates, franchisees and their respective representatives, directors, officers, agents, employees or volunteer staff (the "Activities").
      3.3 The constant in all of these classes is that the Activities involve moving in full ranges of motion, strength training, and postural training. The Activities may involve receiving adjustments from instructors, so please advise in advance if you do not want adjustments.
      3.4 The Activities also apply to any classes made available for online streaming and participation, both live or recorded, or that take place outside of Dominique Gauthier, Body Mind Fitness, or any of its affiliates, franchisees and their respective representatives, directors, officers, agents, employees or volunteer staff facilities, including outdoors. We need you to acknowledge that you are responsible for the safe facilitation of the Activities happening outside of our facilities.

      4. I agree and acknowledge that:
      4.a) I am in proper physical condition to participate in the Activity, and am aware that participation could, in some circumstances, result in physical injury, serious physical injury or death.
      4.b) I understand my physical limitations and am sufficiently self-aware to stop physical activity before I become ill or injured.
      4.c) I am aware that if the Activity occurs outdoors, the streets adjourning the area of the Activity are open to regular vehicular traffic during the Activity and I will obey all traffic laws and regulations.

      5. I accept full responsibility for any Equipment, Product or Technology loaned to me as part of participation in this Activity and commit to return the same in good working order.

      6. Release, Waiver and Indemnity. I hereby release, hold harmless, indemnify and waive any claims against Dominique Gauthier, Body Mind Fitness, or any of its affiliates, franchisees and their respective representatives, directors, officers, agents, employees or volunteer staff., its members, directors, officers, contractors, employees, volunteers, agents, executors, administrators, successors, family members and assigns (the "Released Parties") from any liability and damages arising from death or personal injuries, including the contraction of communicable diseases, however caused, during your participation in the Activities with Dominique Gauthier, Body Mind Fitness, or any of its affiliates, franchisees and their respective representatives, directors, officers, agents, employees or volunteer staff, you are releasing the Released Parties at your own risk and you agree to forfeit any and all forms of legal recourse which may be available to you, including but not limited to any form of damages, as a result of your participation in the Activities. You agree that these provisions above apply to you, your family, heirs, executors or anyone else who may be able to bring a legal action on your behalf in the future.

      7. No warranties or representations have been made to me about the Activity which are not stated on this form. I understand and intend that this document act as the broadest and most inclusive assumption of risk, waiver, release of liability, agreement not to sue and indemnity.

      8. I am aware that there is no obligation for any person to provide me with medical care during the Activity. I understand and acknowledge that:
      a. there may be no aid stations available for the Activity.
      b. if medical care is rendered to me, I consent to that care if I am unable to give my consent for any reason at the time the care is rendered.

      9. I am aware that it is advisable to consult a physician prior to participating in the Activity. If I have consulted a physician, I have taken the physician's advice.

      10. I grant my permission to the Released Party and any transferee or licensee or any of them, to utilize any photographs, motion pictures, videotapes, recordings and other references or records of the Activity which may depict, record or refer to me for any purpose ("Likeness"), including commercial use by the released parties, their sponsors and their licensees. This permission is for use anywhere in the world and on the Internet and for an unlimited period of time. I understand and agree that I will not be compensated or receive additional consideration for consenting to the use of my Likeness and that I will not be given a chance to receive, inspect or approve the promotional or marketing material, messages and/or content that may use my Likeness.

      11. I hereby acknowledge that I may be required to use an automobile to travel to and from the Activity or as part of the Activity. I hereby acknowledge that I have the authority to use such automobile and that the automobile is fully insured for use in the Activity. I accept full responsibility for the automobile and that use of the automobile in the Activity will be at my own risk.

      12. Inherent Risks. You understand that participating in the Activities poses inherent risks, some more obvious/serious than others. These risks can result in serious harm and injuries that could change your quality of life and, in very rare and extreme circumstances, may even result in death.
      12.1 Injuries include but are not limited to things like muscle tears, strains, rhabdomyolysis and other musculoskeletal injuries, sprains, fractures, broken bones, cardiovascular complications, high blood pressure, dehydration, dizziness and fainting.
      12.2 Additional risks posed by participating in the Activities online, as there is no in-person supervision or space provided for you, and you will therefore need to ensure the safety of the Activities, using your judgment how to best practice them, not pushing yourself too far or attempting anything you feel unsure how to perform.
      12.3 Other risks posed for Activities performed outdoors, such as tripping or collision with human or natural elements, sun exposure, dehydration, insects, exposure to infections, diseases, pollutants and other environmental factors. You understand and agree it is your responsibility to ensure a safe space/environment to perform the Activities.
      12.4 Additional risks of Activities for pregnant or post-natal women to the health of your fetus and your body, including but not limited to pregnancy loss, low birth weight, early delivery and postpartum complications.
      12.5 Exposure to and contraction of COVID-19 or other communicable diseases passed on via other participants and use of shared space, surfaces, or Equipment.

      13. Affirmation of Health. By participating in any Activities with Dominique Gauthier, Body Mind Fitness, or any of its affiliates, franchisees and their respective representatives, directors, officers, agents, employees or volunteer staff, you affirm that you have sought medical advice regarding your fitness or are certain of your ability to practice advanced level yoga and pilates. If you have any pre-existing medical conditions (e.g. asthma, diabetes, heart disease), physical injuries, weakness, are pregnant, post-natal or post-surgery, you should consult with your doctor first before engaging in the Activities. Please communicate and inform us IMMEDIATELY if at any point you do not feel well during the Activities.

      14. COVID-19 / Infectious Disease. If at any point within 14 days prior to participating in any of the Activities, you have suffered from symptoms of a communicable disease (including but not limited to fever, chills, cough, shortness of breath, or sore throat), been in close contact with someone with a known or suspected case or in a hot spot area, or else are uncertain of your health or risk of transmission, you agree not to join or participate in the Activities and you should consult with your doctor. You agree to comply with all measures and policies implemented by Dominique Gauthier, Body Mind Fitness, or any of its affiliates, franchisees and their respective representatives, directors, officers, agents, employees or volunteer staff, and applicable public health guidelines as updated, including but not limited to wearing masks, personal hygiene and social distancing, and allowing your temperature to be checked before arriving to class. ((15.1 Consent to Cooperate with Contact Tracing. You understand and agree that Dominique Gauthier, Body Mind Fitness, or any of its affiliates, franchisees and their respective representatives, directors, officers, agents, employees or volunteer staff may disclose your personal information to the relevant authorities as required by law and policies related to the containment of COVID-19 or other communicable disease through contact tracing or for other lawful purposes.

      15. Valuables. You agree that we are not responsible for the loss or damage of any personal property you bring or leave with Dominique Gauthier, Body Mind Fitness, or any of its affiliates, franchisees and their respective representatives, directors, officers, agents, employees or volunteer staff.

      16. General Legal Provisions. Jurisdiction. This Waiver will be governed exclusively by the laws of the Province of Ontario.

      17. Severability. If any provision of this agreement shall be unlawful, void or for any reason unenforceable, then that provision shall be deemed severable from this agreement and shall not affect the validity and enforceability of any remaining provisions.

      18. Entire Agreement. This Waiver constitutes the entire agreement between the parties and replaces any prior agreements. Headings. The headings used in this Waiver are for stylistic purposes only and none of the content in the headings are intended to be legally binding.

      19. Online Agreement. We agree that this Agreement may be signed electronically or agreed to by having you click "I Agree", the effect of which will be the same as signing by hand and the intention of which is that both parties desire to be bound by all the terms of the Agreement.

      20. Continued Agreement. Agreement to this Waiver will act as your continued agreement to all ensuing classes, sessions and/or workshops whether in person, online, or via video conferencing tool.

      21. Voluntary Assumption of Risk. I have read this Waiver and understand the risks of participating in the Activities with Dominique Gauthier, Body Mind Fitness, or any of its affiliates, franchisees and their respective representatives, directors, officers, agents, employees or volunteer staff. My signature below, electronic signature or clicking 'I Agree', and your participation in the classes with Dominique Gauthier, Body Mind Fitness, or any of its affiliates, franchisees and their respective representatives, directors, officers, agents, employees or volunteer staff illustrates your voluntary engagement and assumption of the risks of the Activities.
    • - Discounts cannot be combined with any other offer; only one discount per service/purchase.
      - Payments can be made by cash, cheque, e-transfer or by credit card.
      - Classes and Sessions are 55 minutes unless otherwise denoted.
      - First time participants, please arrive 10-15 minutes early to fill out a waiver.
      - Please arrive 5-10 minutes before your class or session begins; doors will be locked once class begins.
      - We offer a generous 'make-up' policy that allows you to attend any other regular scheduled class within the same session in which you are registered when space is available. Missed classes cannot be used as a discount toward future sessions.
      - Life Happens and we understand. In the event that you cannot attend a class or an appointment, it can be made up as long as you give 24 hours notice. Any appointment missed, late cancelled, or changed without 24 hours notice will result in a charge equal to 100% o reserved service amount. The appointment may be taken off a package or charged individually
      - All classes and sessions are non-refundable and non-transferable.
      - Personal Training & Private Yoga Packages expire 3 months after purchase, unless otherwise denoted.
      - Please avoid use of perfumes, colognes and body sprays within the studio.
      - Cell phones must be turned off while in the studio to give yourself and others around you a well deserved break.
      - Please remove your shoes while inside the studio.
    • Please type your name below as a digital signature that all information is accurate to the best of your knowledge, and that you have read and understood the Terms, Policies and Awknowledgements of the Release & Waiver.